| NPI | 1851182026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0040495) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.546562) |
| 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: PA RN770072) | |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2025-10-03 |